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Background: This randomised, double-blind, placebo-controlled, parallel-group, 52-week Phase III study (MERIT; NCT04607005) assessed mepolizumab efficacy and safety in patients with chronic rhinosinusitis with nasal polyps (CRSwNP)/eosinophilic CRS (ECRS) in Japan, Russia, and China, for which data are limited., Methodology: Eligible patients (enrolled at 60 centres) had blood eosinophil count >2%, endoscopic bilateral NP score ≥5, nasal obstruction visual analogue scale (VAS) score >5, ≥2 sinonasal symptoms, and either previous sinus surgery or systemic corticosteroid use/intolerance. Patients were randomised (1:1) to receive mepolizumab 100 mg subcutaneously or placebo every 4 weeks, plus standard of care. Co-primary endpoints: change from baseline in total endoscopic NP score (ENPS) (Week 52) and nasal obstruction VAS score (Weeks 49-52). Post hoc analyses conducted in a modified intent-to-treat (mITT) population excluded patients from two study sites, related to Good Clinical Practice violations by the Site Management Organisation overseeing these sites. These were considered the primary efficacy analyses., Results: In the mITT population, mepolizumab (n=80) versus placebo (n=83) significantly improved nasal obstruction VAS score from baseline to Week 49-52 and was associated with a trend of total ENPS improvements at Week 52. Mepolizumab/placebo on-treatment adverse events (AEs) occurred in 68/84 and 65/85 patients in the safety population (treatment-related AEs: 2/84 and 5/85, respectively), and on-treatment serious AEs in 0/84 and 4/85 patients, respectively (no fatalities reported)., Conclusions: Mepolizumab was effective and well-tolerated in patients with CRSwNP/ECRS from Japan, Russia, and China.

Background: Loss of smell is one of the most bothersome and difficult-to-treat symptoms in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP)., Methodology: SYNAPSE was a 52-week Phase III study of 4-weekly mepolizumab (100 mg subcutaneously) plus standard of care in adults with severe bilateral CRSwNP. This post hoc analysis assessed changes from baseline to study end in loss of smell visual analogue scale (VAS) symptom score, in patients stratified by several baseline clinical characteristics. SinoNasal Outcomes Test (SNOT)-22 sense of smell/taste item and University of Pennsylvania Smell Identification Test (UPSIT) scores were also assessed., Results: SYNAPSE enrolled 407 patients (mepolizumab=206; placebo=201) with impaired sense of smell at baseline. Improvements from baseline to study end in loss of smell VAS score were greater with mepolizumab versus placebo (treatment difference: -0.37) and most notable in patients with fewer or more recent prior surgeries (treatment difference: 1 vs 2 vs more than 2 prior surgeries,-1.29 vs -0.23 vs -0.07; =3 years since last surgery, -.89 vs 0.22). Approximately 25% of patients had baseline UPSIT scoresavailable; among those scoring =19 by study end. The SNOT-22 sense of smell/taste item score improved with mepolizumab versus placebo., Conclusions: Mepolizumab treatment improved patients' perceived sense of smell, as measured by loss of smell VAS score and SNOT-22 sense of smell/taste item score in patients with severe refractory CRSwNP.

Background: Temperature-controlled radiofrequency (TCRF) device treatment of nasal valve dysfunction (NVD) was superior to a sham procedure control in reducing the symptoms of nasal airway obstruction (NAO) in this randomised controlled trial (RCT)., Methodology: Two-year outcomes for 108 patients actively treated in a prospective, multicenter, patient-blinded RCT were used to determine treatment effect durability and changes in medication/nasal dilator usage. A responder was defined as ≥ 20 reduction in NOSE score or 1 reduction in severity class., Results: The mean (SD) age of patients was 48.5 (12.3) years; 66 (61.1%) women. Baseline NOSE score was 76.3. The 2-year responder rate was 90.4% and NOSE score treatment effect was -41.7; 54.7% improvement. Of 57 patients using medications/nasal dilators at baseline, 45 (78.9%) either stopped all use (33.3%) or stopped/decreased (45.6%) use in >=1 class at 2 years. Concurrent septal deviation, septal swell body, or turbinate enlargement did not significantly affect the odds of exhibiting a NOSE score of ≤ 25 at 2 years., Conclusions: TCRF device treatment of NVD resulted in significant and sustained improvements in the symptoms of NAO at 2 years, accompanied by a substantial reduction in medication/nasal dilator use.

Background: Nasal valve dysfunction (NVD) is a substantial contributor to nasal airway obstruction. Minimally-invasive temp-erature-controlled radiofrequency (TCRF) treatment of the nasal valve is available and comparison with surgical techniques is warranted., Methodology: Databases: Medline (PubMed), Embase, Cochrane Library., Population: adults with preprocedural nasal obstruction symptom evaluation (NOSE) score >=45. Treatment effects were derived from a random effects model and reported as weighted mean difference in NOSE score between baseline; 3, 6, and 12 months postprocedure., Results: Of 2529 initial articles, 5 studies describing TCRF treatment and 63 studies describing functional rhinoplasty were included. Pooled effect sizes for TCRF treatment and functional rhinoplasty were comparable in all analyses., Conclusions: TCRF treatment of the internal nasal valve for NVD was associated with sustained effects comparable to functional rhinoplasty addressing the nasal valve only, rhinoplasty without concomitant turbinate treatment, and all rhinoplasty.

Exchange coupling in a model core-shell system is demonstrated as a step on the path to 3d exchange spring magnets. Employing a model system of Ni@CoFe 2 O 4 , high quality core-shell nanoparticles were fabricated using a simple two-step method. The microstructural quality was validated using TEM, confirming a well-defined interface between the core and the shell. A strongly temperature dependent two-phase magnetic hysteresis loop was measured, wherein an analysis of step heights indicates coupling of roughly 50% between the core and the shell. Element-specific XMCD hysteresis confirms the presence of exchange coupling, suppressing the superparamagnetism of the Ni core at room temperature, and reaching a coercivity of >6 kOe at 80 K. These results provide a pathway to the development of heterostructured metal-oxide exchange coupled nanoparticles with improved maximum energy product.

In March 2023, the European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual Summit in Brussels with expert panel members of EUFOREA, representatives of the EUFOREA patient advisory board, and the EUFOREA board and management teams. Its aim was to define the research, educational and advocacy initiatives to be developed by EUFOREA over the next 2 years until the 10th anniversary in 2025. EUFOREA is an international non-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic allergic and respiratory diseases via research, education, and advocacy. Based on its medical scientific core competency, EUFOREA offers an evidence-supported platform to introduce innovation and education in healthcare leading to optimal patient care, bridging the gap between latest scientific evidence and daily practice. Aligned with the mission of improving health care, the expert panels of asthma, allergic rhinitis (AR), chronic rhinosinusitis (CRS) & European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), allergen immunotherapy (AIT) and paediatrics have proposed and elaborated a variety of activities that correspond to major unmet needs in the allergy and respiratory field. The current report provides a concise overview of the achievements, ambitions, and action plan of EUFOREA for the future, allowing all stakeholders in the allergy and respiratory field to be up-dated and inspired to join forces in Europe and beyond., Competing Interests: HPW: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, Medtronic and Viatris. LS: Honoraria by Allergopharma, DBV Technologies, Sanofi-Aventis, Leti, Nutricia. AD-Boards: Leo-Pharma, GSK, Sanofi-Aventis. SGK: Honoraria for articles, speaker and advisory boards: ALK, Bayer, GlaxoSmithKline, Haleon, Noucor, Sanofi- Regeneron, and Viatris. Chair of BSACI rhinitis guidelines, Scientific Chief Editor, Rhinology Section of Frontiers in Allergy, Board member and AR lead for EUFOREA, and Chair/ member Data Monitoring Committees on SLIT for ALK. BV: Is recipient of consultancy/lecture fees or unrestricted research grants from Sanofi/Regeneron, Novartis, GSK, AZ, ALK Abello and BORK-npc. CAM: Grants, speaker honoraria, consultancy or advisory fees and/or research support all via Technical University of Munich from Allergopharma, ALK Abello, AstraZeneca, Bencard/Allergen Therapeutics, Immunetek, GSK, Novartis, LETI, Roche, Zeller, Sanofi Genzyme, Regeneron, European Institute of Technology, Federal German Ministery of Research and Education. Travel support by EUFOREA, EAACI and DGAKI. DCE: Lecture fees and participations in experts board meeting of GSK, Novartis, Sanofi, Regeneron, Astrazeneca. DR: No conflict of interest to declare related to this work, but declares a general COI arising out of consulting pharmaceutical companies (GlaxoSmithKline, Sanofi, Kymab and Synairgen) and honoraria for speaking (GlaxoSmithKline). FW: The department of Otorhinolaryngology of the Amsterdam University Medical centre, location AMC received grants for research in Rhinology from ALK, AllergyTherapeutics, Novartis, EU, GSK, MYLAN, Sanofi-Aventis, and Zon-MW. WF: Received consultation and/or speaker fees from Dianosic, GSK, Novartis and Sanofi-Aventis/Regeneron. GP: Has participated in advisory boards and received speaker fees from ALK-Abelló, Argenx, AstraZeneca, Genentech, GSK, Novartis, Regeneron, Roche, Sanofi Genzyme, and Stallergenes- Greer. HJK: Research consultant for Sanofi, Regeneron, GlaxoSmithKline, and AstraZeneca. HLG: Has received grant funding, participated in advisory boards and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Hoffmann la Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grants from MedImmune, Novartis UK, Roche/ Genentech Inc, and Glaxo Smith Kline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine and Vitalograph; he has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; he has also taken part in asthma clinical trials sponsored by AstraZeneca, Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he is the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche, and Janssen. JM: Declares a general COI arising out of consulting pharmaceutical companies (BerlinChemie Menarini, AstraZeneca, Chiesi, Stallergenes-Greer, ALK, Novartis) and honoraria for speaking (BerlinChemie Menarini, Chiesi, Stallergenes-Greer, Sanofi, Takeda, Novartis). ME: Has received lecture and/or advisory board fees from Airsonett, ALK, AstraZeneca, Chiesi, Novartis and Sanofi outside the submitted work. MJ: Grants from Mylan Pharma, Noucor/Uriach Group, and GSK. Personal and advisory board fees from Sanofi-Genzyme & Regeneron, Novartis, Mylan Pharma, Noucor/Uriach Group, Mitsubishi-Tanabe, Menarini, UCB, AstraZeneca, GSK, and MSD. RS: Declares a general COI arising out of consulting pharmaceutical companies and/or advisory boards (GlaxoSmithKline, Sanofi, Novartis). SG: Have received speaker fees from ALK-Abello, Meda, Glenmark and funding to attend a conference from GSK and Mylan/Meda. WU: Has received honoraria for advising and lecturing from Viatris, Stallergenes, and ALK. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Hellings, Lau, Scadding, Bjermer, Backer, Chaker, Conti, De Corso, Diamant, Djukanovic, Fokkens, Gevaert, Gray, Han, Heaney, Hoffmann, Jesenak, Johansen, Kumaran, McDonald, Melén, Mullol, Reitsma, Ryan, Scadding, Schmid-Grendelmeier, Teeling, Odemyr and Wahn.)

Severe chronic rhinosinusitis with nasal polyps (CRSwNP) is a debilitating disease with a significant impact on the quality of life (QoL). It is typically characterized by a type 2 inflammatory reaction and by comorbidities such as asthma, allergies and NSAID-Exacerbated Respiratory Disease (N-ERD). Here, the European Forum for Research and Education in Allergy and Airway diseases discusses practical guidelines for patients on biologic treatment. Criteria for the selection of patients who would benefit from biologics were updated. Guidelines are proposed concerning the monitoring of the drug effects that provide recognition of responders to the therapy and, subsequently, the decision about continuation, switching or discontinuation of a biologic. Furthermore, gaps in the current knowledge and unmet needs were discussed.

Background: The SYNAPSE study (NCT03085797) demonstrated that mepolizumab decreased nasal polyp (NP) size and nasal obstruction in patients with chronic rhinosinusitis with NP (CRSwNP)., Methods: SYNAPSE, a randomized, double-blind study, included patients with recurrent, refractory, severe CRSwNP, eligible for repeated surgery despite receiving standard of care (SoC). Patients received 4-weekly mepolizumab 100 mg or placebo subcutaneously plus SoC for 52 weeks. This post hoc analysis further characterized treatment responses and association with patient characteristics. The proportion of patients meeting any and each of five response criteria indicating improvement in disease-specific quality of life, NP size, nasal obstruction, loss of smell, and overall symptoms at Weeks 24 and 52, were assessed in subgroups: 1) no surgery; 2) neither surgery nor systemic corticosteroids (SCS)., Results: Of 407 patients in the intention-to-treat population, 381 and 343 patients had no sinus surgery by Weeks 24 and 52, respectively. More mepolizumab- versus placebo-treated patients without surgery by Weeks 24 and 52 met each response criteria. Of the mepolizumab-treated patients without surgery by Week 24, 109 (55%) responded across >=3 criteria, increasing to 126 (67%) by Week 52. Similar response trends were seen for patients with neither surgery nor SCS by Weeks 24 and 52. At either timepoint, there were no major differences in baseline characteristics between mepolizumab-treated full- (5/5 categories) and non-responders (0/5 categories)., Conclusions: Most patients who completed SYNAPSE required neither surgery nor SCS use and in addition achieved a progressive and sustained clinical response to mepolizumab underscoring the therapeutic benefits of mepolizumab in severe CRSwNP.

Chronic rhinosinusitis (CRS) is known to affect around 5 % of the total population, with major impact on the quality of life of those severely affected (1). Despite a substantial burden on individuals, society and health economies, CRS often remains underdiagnosed, under-estimated and under-treated (2). International guidelines like the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) (3) and the International Consensus statement on Allergy and Rhinology: Rhinosinusitis 2021 (ICAR) (4) offer physicians insight into the recommended treatment options for CRS, with an overview of effective strategies and guidance of diagnosis and care throughout the disease journey of CRS.

Objective: To analyze the level and influence factors of inflammatory factors among electrical workers in Hainan Province. Methods: A total of 509 electrical workers were selected as the research subjects with random cluster sampling in September 2020. Basic information was collected by questionnaire, the serum IL-6, IL-8 and TNF-α levels of the subjects were detected by Luminex.Mann-Whitney U test and Kruskal-wallis H test were used for univariate analysis. Ordinal logistic regression analysis was used for potential influencing factors of the level of inflammatory factors. Results: The median concentrations of IL-6, IL-8 and TNF-α in serum were 2.78, 9.77 and 8.18 pg/ml. Compared with women, male was a risk factor for the increase of IL-6 levels ( OR =1.80, 95% CI : 1.08~3.00, P =0.024) . Compared with 51-60 years old, 21-31 years old ( OR =0.27, 95% CI : 0.18~0.42, P <0.001) , 31-41 years old ( OR =0.27, 95% CI : 0.17~0.43, P <0.001) and 41-51 years old ( OR =0.64, 95% CI : 0.41~0.99, P =0.043) were protective factors for the increase of IL-8 level. Compared with day shift workers, shift work was a risk factor for the increase of IL-8 level ( OR =1.73, 95% CI : 1.21~2.48, P =0.003) . Compared with women, male was a risk factor for the increase of TNF-α levels ( OR =2.87, 95% CI : 1.70~4.86, P <0.001) . Compared with workers who exposed to 7 or more occupational hazard factors, exposed to 1~3 ( OR =0.53, 95% CI : 0.30~0.92, P =0.024) occupational hazard factors were protective factors for the increase of TNF-α levels. Conclusion: The level of inflammatory factors was related to sex, age, work system and occupational environment, which can provide basic data for follow-up research on occupational population.

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a type 2 inflammatory disease with a high symptom burden and poor quality of life. Treatment options include recurrent surgeries and/or frequent systemic corticosteroids (SCS). Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2-mediated inflammation. We report results of pooled analyses from 2 randomised, double-blind, placebo-controlled phase 3 studies (SINUS 24 [NCT02912468]; SINUS-52 [NCT02898454]) to evaluate dupilumab effect versus placebo in adults with CRSwNP with/without SCS use and sinonasal surgery., Methodology: SINUS-24 patients were randomised 1:1 to subcutaneous dupilumab 300 mg (n=143) or placebo (n=133) every 2 weeks (q2w) for 24 weeks. SINUS-52 patients were randomised 1:1:1 to 52 weeks of subcutaneous dupilumab 300 mg q2w (n=150), 24 weeks q2w followed by 28 weeks of dupilumab 300 mg every 4 weeks (n=145) or 52 weeks of placebo q2w (n=153)., Results: Dupilumab reduced the number of patients undergoing sinonasal surgery (82.6%), the need for in-study SCS use (73.9%), and SCS courses (75.3%). Significant improvements were observed with dupilumab vs placebo regardless of prior sinonasal surgery or SCS use in nasal polyp, nasal congestion, Lund-MacKay, and Sinonasal Outcome Test (22-items) scores, and the University of Pennsylvania Smell Identification Test., Conclusions: Dupilumab demonstrated significant improvements in disease signs and symptoms and reduced the need for sino-nasal surgery and SCS use versus placebo in patients with severe CRSwNP, regardless of SCS use in the previous 2 years, or prior sinonasal surgery.

Objective: To evaluate whether switching bipolar radiofrequency ablation (SB-RFA) using three internally cooled wet (ICW) electrodes can induce coagulations >5 cm in porcine livers with better efficiency than consecutive monopolar (CM) or switching monopolar (SM) modes., Methods: A total of 60 coagulations were made in 15 in vivo porcine livers using three 17-gauge ICW electrodes and a multichannel radiofrequency (RF) generator. RF energy (approximately 200 W) was applied in CM mode (Group A, n = 20) for 24 min, SM mode for 12 min (Group B, n = 20) or switching bipolar (SB) mode for 12 min (Group C, n = 20) in in vivo porcine livers. Thereafter, the delivered RFA energy, as well as the shape and dimension of coagulations were compared among the groups., Results: Spherical- or oval-shaped ablations were created in 30% (6/20), 85% (17/20) and 90% (18/20) of coagulations in the CM, SM and SB groups, respectively (p = 0.003). SB-RFA created ablations >5 cm in minimum diameter (Dmin) in 65% (13/20) of porcine livers, whereas SM- or CM-RFA created ablations >5 cm in only 25% (5/20) and 20% (4/20) of porcine livers, respectively (p = 0.03). The mean Dmin of coagulations was significantly larger in Group C than in Groups A and B (5.1 ± 0.9, 3.9 ± 1.2 and 4.4 ± 1.0 cm, respectively, p = 0.002) at a lower delivered RF energy level (76.8 ± 14.3, 120.9 ± 24.5 and 114.2 ± 18.3 kJ, respectively, p < 0.001)., Conclusion: SB-RFA using three ICW electrodes can create coagulations >5 cm in diameter with better efficiency than do SM- or CM-RFA., Advances in Knowledge: SB-RFA can create large, regular ablation zones with better time-energy efficiency than do CM- or SM-RFA.

Dishevelled (Dvl) is a key regulator of Wnt signaling both in the canonical and non-canonical pathways. Here we report the identification of a regulatory domain of ubiquitination (RDU) in the C-terminus of Dvl. Mutations in the RDU resulted in accumulation of polyubiquitinated forms of Dvl, which were mainly K63 linked. Small interfering RNA-based screening identified Usp14 as a mediator of Dvl deubiquitination. Genetic and chemical suppression of Usp14 activity caused an increase in Dvl polyubiquitination and significantly impaired downstream Wnt signaling. These data suggest that Usp14 functions as a positive regulator of the Wnt signaling pathway. Consistently, tissue microarray analysis of colon cancer revealed a strong correlation between the levels of Usp14 and β-catenin, which suggests an oncogenic role for Usp14 via enhancement of Wnt/β-catenin signaling.

Objective: To investigate the potential diagnostic value of dual-energy CT (DECT) with virtual non-enhanced (VNE) and iodine-only images, and to determine the optimal mixed ratio of blended images for evaluation of pancreatic diseases., Methods: Multiphasic DECT was performed in 44 patients with focal pancreatic disease. DECT was used during the pancreatic and hepatic venous phases, and a peak kilovoltage of 120 kVp was used for both non-contrast phases. For qualitative analysis of the CT images, two radiologists assessed three image sets (VNE, iodine-only and blended images) in order to determine the acceptability of VNE in replacing true non-enhanced (TNE) images, the added value of iodine-only images and the preferred blending ratio. For quantitative analyses, the CT numbers and image noise of the pancreatic parenchyma, lesions, aorta and psoas muscle were measured. The contrast-to-noise ratio of the lesion was calculated on the pancreatic phase images. The effective radiation dose for DECT and TNE images was calculated. Statistical comparisons were made using the Friedman test, the Wilcoxon test, the paired t-test and repeated measures of analysis of variation with Bonferroni correction for multiple comparisons., Results: The level of acceptance of the VNE images in replacing TNE images was 90.9%. Regarding the iodine-only images, 50% of the cases were found to have an added value. The linear-blended images with a weighting factor of 0.5 were preferred., Conclusions: DECT was able to provide high-quality VNE images that could replace TNE images and iodine-only images showing an added value. Blended images with a weighting factor of 0.5 were preferred by the reviewers.

Objective: The objective of this study was to determine the incidence of typical and atypical enhancement patterns of hepatocellular carcinomas (HCCs) on multiphasic multidetector row CT (MDCT) and to correlate the enhancement patterns and morphological image findings of HCC with the degree of tumour differentiation., Methods: MDCT images of 217 patients with 243 surgically proven HCCs were evaluated through consensus reading by two radiologists. Our MDCT protocol was composed of precontrast, arterial, portal and delayed phases. The reviewers analysed the CT images for degree of attenuation; relative timing of washout; presence of dysmorphic intratumoral vessels, aneurysms and necrosis; tumour size; tumour margin; presence of pseudocapsule; intratumoral heterogeneity; and determined enhancement pattern. The imaging features were correlated with tumour differentiation using Fisher's exact test or the χ(2) test., Results: Among 243 HCCs, 137 (56.4%) showed the typical enhancement pattern of HCC, which is arterial enhancement and washout on portal or equilibrium phase images. In the arterial phase, 190 of 243 (78.2%) HCCs showed hypervascularity, with approximately three quarters of poorly differentiated (PD) (34 of 45, 75.6%) and moderately differentiated (MD) HCCs (92 of 123, 74.8%) showing washout during the portal or delayed phases, vs only 50% of well-differentiated (WD) HCCs (11 of 22; p<0.048). The presence of intratumoral vessels and aneurysms, tumour necrosis, attenuation of precontrast, the relative timing of washout, intratumoral attenuation heterogeneity, tumour margin and tumour size were correlated with the pathological differentiation of HCCs (p<0.05)., Conclusion: A typical enhancement of HCCs on MDCT was not unusual (43.6%) and WD and PD HCCs account for most of the atypical enhancement patterns. Early washout favoured MD and PD HCCs rather than WD HCCs, whereas in our study the presence of intratumoral aneurysm was a highly specific finding for PD HCC.

Objectives: The objective of this study was to determine the in vivo efficacy of radiofrequency ablation (RFA) in porcine liver using Octopus® electrodes for creating a large coagulation compared with RFA using clustered electrodes., Methods: A total of 39 coagulations were created using a 200-W generator and clustered electrodes or Octopus electrodes during laparotomy in 19 pigs. Radiofrequency was applied to the livers using four protocols: (1) Group A-1, monopolar mode using a clustered electrode (n=11); (2) Group A-2, monopolar mode using an Octopus electrode (n=11); (3) Group B-1, consecutive monopolar mode using three, clustered electrodes (n=8); and (4) Group B-2, switching monopolar mode using two Octopus electrodes (n=9). The energy efficiency, shape, diameters (D) and volume (V) of the coagulation volume were compared in each of the two groups., Results: The mean maximum D and V of the coagulations in Group A-2 (4.7 cm and 33.1 cm(3), respectively) were significantly larger than those in Group A-1 (4.1 cm and 20.3 cm(3), respectively) (p<0.05). Furthermore, the mean minimum D, maximum D and V of the coagulations in Group B-2 were significantly larger than those in Group B-1, i.e. 5.3 vs 4.0 cm, 6.6 vs 4.9 cm and 66.9 vs 30.2 cm(3), respectively (p<0.05). The energy efficiencies were also significantly higher in Groups A-2 and B-2 than in Groups A-1 and B-1 (p<0.05)., Conclusion: The Octopus electrodes were more efficient for creating a large ablation zone than clustered electrodes, and the efficacy of RFA with Octopus electrodes can be amplified in the switching monopolar mode.

Neurological complications of scrub typhus are reported to be rare. Peripheral nervous system involvement has been reported in only one case. We present two cases of Guillan-Barré syndrome (GBS) associated with scrub typhus. In both cases, the findings of an elevated indirect immunofluorescent antibody titer for Orientia tsutsugamushi and nerve conduction study showing sensory-motor polyneuropathy, have led us to believe that scrub typhus could be one of the antecedent illnesses associated with GBS.

The aim of this study was to determine the characteristic MR findings of the anomalous insertion of the medial meniscus (AIMM) into the anterior cruciate ligament (ACL), and to document potential pitfalls in its interpretation. We reviewed 1326 consecutive knee arthroscopic studies to identify patients with an AIMM. 30 knees of 26 patients (4 females, 22 males; average age, 31.3 years; range, 14-50 years) were included in this study. We evaluated the presence of an AIMM and analysed the MR findings, including the ACL attachment sites of the AIMMs, the absence of the transverse ligament, meniscal tears and a discoid meniscus. AIMMs were detected by MR imaging in 16 knees of 18 patients (60%, 18/30). The AIMMs showed a linear band with low signal intensity on T2 weighted sagittal images running parallel to the ACL. The AIMMs were inserted into the lower portion of the ACL in eight knees, the middle portion in five knees, and the intercondylar notch in five knees. Meniscal tears (10 medial, 10 lateral) were found in 20 knees of 16 patients. Six knees of five patients showed a discoid meniscus. 15 knees of 14 patients showed no transverse ligament on MR imaging. An AIMM has the potential to be misinterpreted as a meniscal tear, ACL tear or infrapatellar plica on knee MR imaging. Familiarity with the characteristic MR findings can aid in the detection of an AIMM into the ACL.

The purpose of this study was to compare the amounts of in vivo coagulation obtained by radiofrequency (RF) ablation in porcine lung, using three types of electrodes. 15 in vivo ablation procedures were performed in the lungs of five pigs using three kinds of currently available RF devices under CT guidance. After placing an electrode in the lung, three ablation zones were created at each of three different regimens: Group A: RF ablation with an internally cooled electrode; Group B: RF ablation with a perfusion electrode, with instillation of 0.9% NaCl solution at a rate of 1.5 ml min(-1); Group C: RF ablation with a multitined expandable electrode. According to the manufacturer's recommendations, RF application times were 12 min in group A and 20 min in group B. In group C, RF energy was delivered for 7 min after a mean temperature of 110 degrees C was reached at 5 cm deployment. 36 min after the procedures, contrast-enhanced CT scans were obtained to evaluate the volume of zone of coagulation, and lungs were harvested for gross measurements. After macroscopic and histopathological analyses of 5 mm-thick lung sections, diameters, volumes and variation coefficients of regions of central coagulation were assessed. During RF ablation, the perfusion electrode allowed a larger energy delivery than the internally cooled or the multitined expandable electrodes, i.e. 33.6+/-4.7 kJ in group A, 40.0+/-8.2 kJ in group B and 23.5+/-6.1 kJ in group C (p<0.05). On gross observation, the cut surface of the gross specimen containing RF-induced coagulation showed that the ablated tissue appeared to be a central, firm, dark-brown area surrounded by an irregular outer margin (approximately 3-10 mm thick) of bright red tissue. In vivo studies showed that RF ablation using the perfusion electrode achieved larger coagulation volume than RF ablation using the other electrodes (p<0.05): 7.2+/-4.1 cm3 in group A; 16.9+/-5.5 cm3 in group B; 7.5+/-3.3 cm3 in group C. The corresponding variation coefficients were 0.55, 0.31, and 0.45, respectively. Our study shows that RF ablation using a perfusion electrode achieves a larger coagulation volume with an irregular margin than RF ablation using internally cooled or multitined expandable electrodes in the porcine lung.

Aim: To compare wet and dry preparation methods for computed tomography colonography (CTC) in terms of preparation quality, interpretation time, and diagnostic performance for polyp detection in a population with a high residue diet., Materials and Methods: Eighty-six patients were divided into two groups. Group 1 (n=24) received a wet preparation of 4l polyethylene glycol (PEG) solution, and group 2 (n=62) received a dry preparation of phosphor-soda. Abnormal findings, including polyps, and the time required to interpret the CTC images in both groups were documented by a radiologist. CTC findings were compared to those of colonoscopy as a reference standard. Two radiologists evaluated the quality of CTC with regard to residual fluid, faeces, and colonic distension using a four-point scale in consensus. Statistical differences for residual fluid, faeces, distensibility on CTC, and interpretation time between the two groups were analysed. The diagnostic performance of CTC in both groups was also compared., Results: One-hundred and ninety polyps in 70 patients were identified using colonoscopy. Regarding the quality of images produced the wet preparation was significantly better than the dry preparation (p<0.05). The average interpretation time was significantly shorter for the wet group (11.7 min) than the dry group (16.4 min) (p<0.05). For per-patient analysis, the positive predictive value (PPV) was significantly better for the wet (100%) than the dry group (79.6%; p=0.025). Sensitivities and PPV for >or=10 mm polyps were comparable between two groups (p>0.05)., Conclusion: In a population with a high-residue diet, CTC with wet preparation can be interpreted in a time-efficient manner and is comparable with CTC with dry preparation.

Two adult patients with histopathologically proved cavernous lymphangiomas and one adult patient with lymphangiomas of strongly presumed cavernous type by cytologic and computed tomographic findings are reported. On computed tomograms, multiple, aggregated, small, and tiny cysts without a solid portion, along the lymphatic channels are characteristic computed tomographic findings for cavernous lymphangiomas.

Purpose: To determine optimal parameters for bipolar radiofrequency ablation (RFA) using perfusion-cooled electrodes to create a large ablation volume in ex vivo bovine liver., Material and Methods: Three sets of RF experiments were performed using a 200-Watt generator and two 15-gauge perfusion-cooled or internally cooled electrodes in ex vivo bovine livers. In the first set of experiments, to find the ideal inter-electrode distance for creating large coagulation necrosis, 30 ablation lesions were created by bipolar RFAs at inter-electrode spacings of 3 cm, 4 cm, and 5 cm. In the second set of experiments, to explore the ideal duration of RF application, bipolar RFAs were performed for 10 min and 20 min. In the first and second experiments, 10 lesions were made for each condition with infusion of 6% hypertonic saline (HS) at 2 ml/min. In the third set of experiments, 10 ablation lesions were created by bipolar RFAs using internally cooled electrodes without HS infusion. The mean volume of those ablation lesions was then compared to that of the lesions created by bipolar RFA using perfusion-cooled electrodes in the second experiments. Tissue impedance, dimension, and shape of the ablated areas were compared in each condition., Results: In the first set of experiments, bipolar RFA created a homogeneous oval or spherical-shaped ablation area between the electrodes at 3-5 cm spacing, but showed a more spherical-shaped lesion at 3 cm inter-electrode spacing than at 4 cm and 5 cm spacing. In the second set of experiments, RF energy delivered for 20 min created a larger dimension of coagulation necrosis than energy delivered for 10 min: 107.6 +/- 34 cm3 versus 59.5 +/- 27 cm3 (P<0.05). In addition, the mean volume of ablation regions obtained with bipolar RFA using the internally cooled electrode was 47.5+/- 17 cm3, which was significantly less than that with bipolar RFA using perfusion-cooled electrodes (P <0.05)., Conclusion: Bipolar RFA using perfusion-cooled electrodes achieves homogeneous areas of coagulation necrosis between two electrodes, preferably at 3 or 4 cm inter-electrode distance for 20 min, and is better in creating large coagulation necrosis than bipolar RFA using internally cooled electrodes.

Aim: To describe the pathology of focal areas of low attenuation in small gastrointestinal stromal tumours on contrast-enhanced computed tomography (CT), and to investigate the association of these areas as predictors of malignant potential., Materials and Methods: Contrast-enhanced helical CT images were obtained of 39 small (up to 5 cm) gastrointestinal stromal tumours. Focal areas of low attenuation were retrospectively evaluated and correlated with histopathological findings. The relation between the mitotic rate of and the presence of focal areas of low attenuation in the tumours was analyzed using Fisher's exact test., Results: Of the 39 small gastrointestinal stromal tumours, 15 contained focal areas of low attenuation on CT. These were found to be due to solid tumour (n=5), haemorrhage (n=3), haemorrhage with necrosis (n=2), cystic degeneration (n=2), fluid in ulcer (n=2), and fibrous septum (n=1); they were not found to be associated with a high mitotic rate (p=0.45)., Conclusion: Focal areas of low attenuation on CT in small gastrointestinal stromal tumours represent varying pathological conditions and do not predict malignant potential.

Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man.

The purpose of this paper was to demonstrate the efficacy of the dual probe bipolar radiofrequency (RF) system with the perfused-cooled electrodes inducing coagulation necrosis in the ex vivo bovine liver. The perfused-cooled electrode that allows simultaneous internal cooling and interstitial hypertonic saline perfusion has been developed for RF ablation (RFA). RF was applied to excised bovine liver in a bipolar mode at 150 W using a 200 W generator with two perfused-cooled electrodes for 10 min. After placing the electrodes at 3 cm spacing in the explanted liver, 45 ablation zones were created with three different regimens: Group A, using both intraelectrode cooling and interstitial perfusion; group B, using only the intraelectrode cooling; and group C, using only interstitial perfusion. In groups A and C, RFA was performed with the infusion of 6% hypertonic saline at the rate of 2 ml min(-1). During RFA, we measured the tissue temperature at the midpoint between the two electrodes. The dimensions of the ablation zones and the changes in impedance, currents and liver temperature during RFA were compared in these three groups. The mean tissue impedance during RFA in group A (56.7+/-21.7 Omega) and group C (56.9+/-20.6 Omega) was significantly lower than group B (112+/-19.7 Omega) (p<0.001). The mean current was higher in group A (1765+/-128 mA) than groups B (760+/-321 mA) and C (1298+/-349 mA) (p<0.05). In addition, the shortest vertical diameter of coagulation necrosis was greater in groups A (4.9+/-0.5 cm) and C (4.6+/-0.7 cm) than in group B (3.5+/-0.4 cm) (p<0.05). The temperature at the mid-point between the two probes was higher in group A than other groups: 99 degrees C in group A, 88.9 degrees C in group B, and 94.3 degrees C in group C (p>0.05). The ratios of the diameter of the long-axis to the diameter of the vertical-axis of groups A, B and C were 1.1+/-0.1, 1.2+/-0.1, and 1.1+/-0.2, respectively (p<0.05). Bipolar RFA using intraelectrode cooling and the interstitial saline perfusion simultaneously produced ablation zones significantly larger than the area produced by only one measure.

The purposes of this essay are to illustrate the technology overview and theoretical benefits of real-time compound ultrasonography (US) and to present our preliminary clinical experience in the evaluation of normal and diseased abdomens. The application of compounding principles to real-time US and its recent reintroduction into mainstream commercial systems have offered new opportunities for its clinical application to the routine examination of the abdomen. In our early preliminary experience, this technique effectively suppressed many of the US artifacts, better depicted the margin or boundary of the lesion, and increased contrast resolution or lesion conspicuity. Therefore, we believe that real-time compound US is a promising technique that may enhance the diagnostic confidence of the examination in the evaluation of normal and diseased abdomens.

Background: We assessed computed tomographic (CT) features of postoperative complications and recurrent tumors in gastric cancer patients who underwent radical surgery., Methods: We performed a retrospective study of 397 patients who had undergone radical surgery for the treatment of gastric carcinoma and underwent postoperative CT in our institution over a 2-year period. Patients were assigned to one of two groups: group A consisted of 47 patients who underwent CT for complications in the early postoperative period, and group B consisted of 355 patients who underwent CT for evidence of tumor recurrence during the follow-up period. We classified recurrent tumors into four categories: local recurrence, lymph node metastasis, peritoneal seeding, and remote metastasis., Results: In group A, localized fluid collections or abscesses in the surgical bed were found in 38 patients (81%) and usually involved the left subphrenic area (74%) or the superior recess of the lesser sac (47%). In group B, recurrent tumors were found in 196 patients (55%). Among these, lymph node metastasis was the most common pattern (52%), followed by peritoneal seeding (44%), local recurrence (40%), and remote metastasis (37%)., Conclusion: CT after radical surgery for the treatment of gastric carcinoma frequently shows postoperative complications or tumor recurrence. Familiarity with the common postoperative complications and patterns of the tumor recurrence is a prerequisite to accurate interpretation of CT findings in these patients.

Background: To optimize hepatic arterial phase timing in contrast-enhanced dynamic ultrasonography (US) of the liver., Methods: Dynamic US was performed by using a microbubble-specific mode in 22 healthy volunteers after bolus injection of SH U 508A. Images were analyzed to determine whether hepatic arterial and portal venous phases could be temporally discriminated. Delay times to contrast enhancement at the hepatic artery (A(ini)) and portal vein (P(ini)) and the delay time until the signals between both vessels became inseparable (A(end)) were determined., Results: The hepatic arterial and portal venous phases could be temporally discriminated in all subjects. A(ini), P(ini), and A(end) (mean +/- standard deviation) were 11.0 +/- 2.0, 14.8 +/- 3.6, and 22.6 +/- 5.1 s, respectively., Conclusion: In hepatic contrast-enhanced dynamic US, hepatic arterial phase scanning should be commenced earlier than 11 s and terminated after 23 s postinjection.

Background: We reviewed the computed tomographic (CT) findings of afferent loop obstruction and assessed the value of helical CT in determining the underlying cause., Methods: Helical CT scans of 18 patients (12 men and six women; age range = 35-67, mean age = 50 years) with afferent loop obstruction were reviewed. All patients had gastric cancer. Ten patients had undergone radical subtotal gastrectomy with Billroth II gastrojejunostomy, and eight had undergone total gastrectomy with Roux-en-Y esophagojejunostomy. CT images were analyzed retrospectively, and the presumed cause of obstruction on CT was compared with surgical findings (n = 8) and clinical courses (n = 10)., Results: Local recurrence (n = 15), peritoneal seeding (n = 1), internal hernia (n = 1), and adhesion (n = 1) were the presumed causes of obstruction on CT. In all eight patients who underwent a second operation, the cause of afferent loop obstruction was correctly suggested on CT (local recurrence in six patients and adhesion and internal hernia in one patient). In 10 patients who were not re-explored, the clinical findings or biopsy indicated recurrent tumor as suggested on CT., Conclusion: Recurrent tumors and other potential causes of afferent loop obstruction can be correctly predicted with CT in most cases.

Amyloidosis is a disease characterized by the deposition of fibrillar protein amyloid of beta-structure in organs or tissues. It is usually classified as either a primary disease or secondary to a co-existent condition, such as rheumatoid arthritis, tuberculosis, or neoplasm (particularly multiple myeloma or renal cell carcinoma). Amyloid protein deposition can be seen in a variety of organs though it occurs with higher frequency in the gastrointestinal tract, kidney, and heart. Amyloidosis can have a wide spectrum of manifestations in nearly every abdominal organ. Some of these, for example, multiple cystic submucosal masses of the stomach, amyloidosis of the gallbladder, and dirty soft tissue infiltration of the subcutaneous fat, have not yet been covered in the radiological literature. The combination of various imaging techniques and the identification of characteristic computed tomography (CT) hepatic features may help in the differentiation of amyloidosis from other infiltrative diseases; however, confirmative diagnosis can usually only be achieved by tissue biopsy.

Most bronchogenic cysts occur in the mediastinum. However, they may be found near any organ derived from the embryonic foregut, even in the extrathoracic region. We report a case of subphrenic bronchogenic cyst that was initially confused with a solid lesion because of its unusual location and atypical appearance on ultrasonography, computed tomography, and magnetic resonance imaging.

Background: We investigated the radiologic findings and clinical course of focal eosinophilic infiltration in the liver., Methods: We retrospectively reviewed computed tomographic (CT) and sonographic scans in 20 patients (18 male, two female; mean age, 50 years) with pathologically or clinically proven focal eosinophilic infiltration in the liver by two experienced radiologists in our institute from August 1995 to June 1999. We also correlated radiologic findings with peripheral eosinophil count. Radiologic and clinical findings during the follow-up (range, 2-49 months; mean, 19.5 months) also were analyzed., Results: Clinical symptoms and signs included abdominal pain (n = 4), easy fatigability (n = 3), weight loss (n = 1), and peripheral eosinophilia (n = 19). Twelve patients were asymptomatic. On sonographic examinations, all lesions were seen as focal, low echoic nodules. On CT, the lesions appeared isoattenuated or low attenuated in the arterial phase and low attenuated in the portal phase, except one case that showed high attenuation in the arterial phase. The margins of most lesions appeared poorly defined. Lesions were single (n = 9) and multiple: two to five (n = 6), six to 10 (n = 3), and more than 10 (n = 2). Each lesion was smaller than 2 cm; only one was 4 cm in diameter. The distribution of the lesion was subcapsular in 14 patients and central in five. Diffuse dissemination was observed in one. Eosinophil-associated abnormality was not present in other abdominal organ in all cases. The peripheral eosinophil count correlated closely with the number but not with the size of lesions. Sixteen patients who had follow-up images showed complete (n = 14) or partial regression of the lesions with a decrease in size (n = 1) or number (n = 1) after 2-22 months (mean, 6.4 months)., Conclusion: Focal eosinophilic infiltration in the liver had somewhat characteristic radiologic findings on sonography and CT. In the correct clinical context of peripheral eosinophilia and self-limited course, these radiologic findings may be helpful in differentiating this condition from other focal hepatic lesions.

Background: We describe the thin-section helical computed tomographic (CT) findings of biliary obstruction caused by metastasis., Methods: Thin-section helical CT (5 mm slice thickness, 1:1 pitch, portal phase) and direct cholangiography in 50 consecutive patients with biliary obstruction caused by metastases were reviewed retrospectively by three radiologists. The primary sites were the stomach ( n = 36), colon ( n = 12), jejunum ( n = 1), and uterus ( n = 1). The level of biliary obstruction was analyzed with the Bismuth classification, and the CT findings of biliary obstruction were classified into six types: small (<2 cm) periductal masses, large (>/=2 cm) periductal masses, extrinsic compression by a metastatic liver mass, high-attenuation intraductal mass, intrapancreatic mass, and no demonstrable lesion., Results: The level of biliary obstruction was the hilum in 18 patients (36%), the proximal common duct in 20 (40%), the distal common duct in five (10%), and the periampullary area in seven (14%). Of 18 hilar obstructions, tumor involvement of the secondary confluence of intrahepatic bile ducts was seen in 10 (right in six, left in one, and bilateral in three). Periductal masses were seen in 68% (small in 18, large in 16). In one patient (2%), a large metastatic mass of the liver resulted in extrinsic compression and biliary obstruction. Lesions mimicking primary biliary or pancreatic tumor were seen in four, respectively. In seven, we found no obstructing lesion on CT., Conclusion: Biliary obstruction in patients with known primary malignancies can show atypical patterns mimicking primary pancreatobiliary malignancies on thin-section helical CT.

Background: We investigated spiral computed tomographic (CT) findings and underlying hemodynamic alterations in acute hepatic vein occlusion., Methods: In nine dogs, immediately after balloon occlusion of the right ( n = 4) or left ( n = 5) hepatic vein through the transjugular or transfemoral route, we performed single-level dynamic CT with intravenous administration of contrast medium. We created time attenuation curves of individual hepatic segments showing attenuation differences. To investigate underlying hemodynamic alterations, hepatic arteriograms were obtained in two dogs., Results: In all cases, there were three compartments with different time attenuation curves: normal, occluded, and adjacent. The normal compartment, which comprised segments far from the occluded hepatic compartment, showed the normal pattern of hepatic enhancement. The occluded compartment, which was the drainage territory of the occluded hepatic vein, showed high attenuation in the early arterial phase and low attenuation in the portal phase. The adjacent compartment, which shared the same portal vein with the occluded compartment and was drained by the patent hepatic vein adjacent to the occluded one, showed strong contrast enhancement in the late arterial and early portal phase. Spiral CT and hepatic arteriography demonstrated the arterioportal shunt and reversed portal venous flow in the occluded compartment, which drained into the adjacent compartment., Conclusion: Acute hepatic vein occlusion on spiral CT appears as mild, early arterial, high attenuation and portal low attenuation of the occluded compartment and strong enhancement in the late arterial and early portal phases of the adjacent compartment due to arterioportal shunt and reversed portal flow.

We have isolated Xenopus homolog of poly(A) binding protein II (XPABPII) and examined its expression during early embryogenesis and embryonic gut development. XpabpII encodes a nuclear protein of 296 amino acids that contains an alpha-helical coiled-coil domain and a ribonucleoprotein-type RNA binding domain. XpabpII is expressed both maternally and zygotically. In gastrula and neurula embryos, XpabpII is expressed mainly in ectoderm, neural and epidermal. From tailbud through to tadpole stages, the neural tissue specific expression of XpabpII gradually becomes confined to the specific vesicle regions of developing brain, being detected in the eye, olfactory pit, telencephalon and mesencephalon, but being excluded from the diencephalon region. Intriguingly, XpabpII transcripts are observed in differentiating gut endoderm. XpabpII first becomes visible in the anterior part of a stage 35 embryonic gut in which prospective liver, stomach and pancreas are located. During further development, uniform expression in anterior gut gradually becomes restricted to the pancreas rudiment. At the seventh day of development, when the gut has formed a complex coiled structure in which each organ contains clearly differentiated cell type, XpabpII is detectable exclusively in the pancreas. Taken together, we suggest that XpabpII plays a specific role in the polyadenylation process of genes involved in brain and pancreas development.

Mucosa-associated lymphoid tissue (MALT) is found in the surface epithelium of the stomach. MALT lymphoma is extranodal lymphoma originating from MALT. In the stomach, a strong association with Helicobacter pylori infection has been demonstrated. Low-grade gastric MALT lymphoma has been reported to have variable features at upper gastrointestinal (UGI) examination. Twenty-two patients with low-grade MALT lymphoma had ulcers (n = 11), fold thickening (n = 7), mucosal nodularity (n = 7), masses (n = 6), or prominent areae gastricae (n = 4) at UGI examination. Six patients with high-grade MALT lymphoma had masses (n = 4), fold thickening (n = 3), ulcers (n = 1), or mucosal nodularity (n = 1) at UGI examination. These findings were similar to those in gastric carcinoma or gastritis. Differentiation of low-grade MALT lymphoma from gastritis or gastric carcinoma was more difficult than differentiation of high-grade MALT lymphoma. Lesions of MALT lymphoma associated with H pylori gastritis were diffuse or multiple in 65% of cases; however, lesions of MALT lymphoma without proved H pylori gastritis were focal or solitary in 80% of cases. Therefore, multiplicity of lesions in MALT lymphoma was closely associated with H pylori infection.

Rationale and Objectives: To investigate the feasibility of recent contrast-specific ultrasound techniques in depicting vascular flow and the effects of changing the output power of the transducer and insonation mode on contrast enhancement, the authors performed an experimental study with a flow phantom., Methods: While changing the mechanical index and the sound insonation mode (continuous and intermittent), images were obtained with three contrast-enhanced ultrasound techniques: fundamental, second-harmonic, and pulse-inversion harmonic imaging (PIHI) after a bolus injection of microbubble contrast agent. The images were compared on a time-intensity curve., Results: In assessing fixed flow (10 cm/s), PIHI showed the best depiction of flow signal. In intermittent scanning, increases in the mechanical index caused stronger flow signals and longer enhancement duration in all techniques. However, continuous scanning revealed poor depiction of flow signal regardless of the technique or changes in the mechanical index because of significant bubble destruction., Conclusions: Microbubble-enhanced PIHI with intermittent scanning at a high mechanical index can depict vascular flow highly effectively without shortening the duration of enhancement.

We have isolated a novel acetyltransferase from Xenopus laevis, named Xat-1. Xat-1 cDNA encodes a predicted protein of 846 amino acids that contains tetratricopeptide repeat (TPR) domains mediating protein-protein interactions and a bipartite nuclear localization signal (NLS). Its apparent molecular mass of 98.8 kDa was determined by SDS-PAGE analysis of Xat-1 recombinant protein in vitro translated in rabbit reticulocyte lysate. Xat-1 is homologous to N-terminal acetyltransferase 1 (NAT1), a gene that was originally discovered in yeast. Furthermore, it has many orthologs from human, mouse, Drosophila, C. elegans, and even Arabidopsis, thereby suggesting that these constitute a novel acetyltransferase family whose functions have been not examined. Xat-1 transcripts are expressed at relatively constant levels throughout early embryonic stages. They also exhibit dynamic expression pattern in brain, somites, branchial arches, pronephros, and otic vesicles., (Copyright 2001 Academic Press.)

Objective: We reviewed the 15-year experience of our institution (Medical College of Wisconsin, Milwaukee, WI) in managing sinonasal inverting papilloma, examining trends in diagnosis and treatment., Study Design: Retrospective., Methods: Thirty-seven patients with inverting papilloma were treated from 1986 to 1999. Demographic data, clinical presentations, pathological findings, surgical approaches and procedures, and recurrence rates were collected retrospectively. Each lesion was categorized into one of four groups based on computed tomography scans and endoscopic findings. This categorization was developed to compare various surgical approaches for tumors in each group., Results: Thirty-one patients had complete information for inclusion in our study. Nineteen patients were treated endoscopically with an average follow-up of 50 months. Eight patients were in group I, five were in group II, six were in group III, and no patients were in group IV. The recurrence rate for the endoscopic group was 10%. Twelve patients underwent lateral rhinotomy or sublabial degloving approach with an average follow-up of 58 months. Five patients were in group I, three patients were in group II, 1 patient was in group III, and three patients were in group IV. The recurrence rate for the external group was 8%. Difference in recurrence rates (P =.85) was not observed between the endoscopic and external approach groups. Regardless of approach, patients who had primary resection had a recurrence of 0%, whereas those with secondary resection had a recurrence of 17% (P =.10)., Conclusions: Technological advancements have led to a trend of detecting sinonasal inverting papilloma before extension beyond the sinonasal region. Difference in recurrence rates was not observed between the endoscopic and the external approach groups. Recurrence rates are lower for primary resection versus secondary resection, regardless of surgical approach.

Background: Streptococcus milleri, a commensal organism, has the potential to cause significant morbidity. There is a paucity of published data regarding this organism in the head and neck., Objectives: To identify and assess the presentation, treatment, and outcomes of pediatric patients affected by this pathogen., Study Design: Review of the Department of Pathology database at Children's Hospital of Wisconsin, Milwaukee, between 1997 and 1999 identified 26 patients with cultures positive for S milleri group (SMG) bacteria. Retrospective chart analysis examined the demographic data, site of origin of infection, additional organisms cultured, symptoms, treatments, and complications., Results: Sixteen patients had SMG infections involving the head and neck region. Sites of origin included the paranasal sinuses, dental, facial soft tissues, deep neck spaces, peritonsillar region, and a tracheostomy site. The paranasal sinuses were the most common site in 37% (6/16). Streptococcus milleri was the only isolate in 69% (11) of the infections. Significant local extension occurred in 56% (9/16) of the patients and included the orbit, skull base, cranium, and deep neck spaces. All patients had surgical drainage and 15 also received intravenous antibiotic treatment. One complication of osteomyelitis of the frontal bone occurred with resolution after surgical debridement and intravenous antibiotic treatment., Conclusions: Streptococcus milleri can be an aggressive pathogen in the head and neck with a propensity for abscess formation and local extension of the infection in a pediatric population. Surgical drainage with antibiotics is generally successful in management of the condition. However, emerging penicillin resistance and the ability for local extension require suspicion of incomplete treatment if clinical symptoms persist.

Purpose: To determine the prevalence of arterioportal shunt associated with hepatic hemangiomas, describe the two-phase spiral computed tomographic (CT) findings, and correlate the presence of arterioportal shunt with the size and rapidity of enhancement of hemangiomas., Materials and Methods: The study group consisted of 109 hepatic hemangiomas in 69 patients who underwent two-phase spiral CT during 1 year. CT scans were obtained during the hepatic arterial (30-second delay) and portal venous (65-second delay) phases after injection of 120 mL of contrast material (3 mL/sec). Arterioportal shunts were diagnosed when hepatic arterial phase CT scans showed a wedge-shaped or irregularly shaped homogeneous enhancement in the liver parenchyma adjacent to the tumor and when portal venous phase CT scans showed isoattenuation or slight hyperattenuation, compared with normal liver in that area, and when there was no demonstrable cause of these attenuation differences. The presence of arterioportal shunt in hemangioma was correlated with the size of the tumor and the rapidity of intratumoral enhancement., Results: Arterioportal shunt was found in 28 (25.7%) of 109 hemangiomas. There was no statistically significant relationship between lesion size and presence of the arterioportal shunt (P =.653). Arterioportal shunt was more frequently found in hemangiomas with rapid enhancement (P <.01)., Conclusion: Arterioportal shunts are not uncommonly seen in hepatic hemangiomas at two-phase spiral CT. Hemangiomas with arterioportal shunts tend to show rapid enhancement.

Background: To evaluate the diagnostic potential of spiral computed tomographic (CT) cholangiography with minimum intensity projection (minIP) in the diagnosis of patients with suspected biliary obstruction., Methods: Nine consecutive patients with obstructive biliary disease were enrolled in this study. Spiral CT data (3-mm slice thickness, pitch 1-2:1) obtained 65 s after the start of contrast medium injection (150 mL Ultravist 370, 3 mL/s) were reconstructed at 1-mm intervals. Three-dimensional (3D) CT cholangiography with minIP (3D CTC) was generated with a Siemens software package. The quality of 3D CTC in its ability to demonstrate the anatomic detail, the level of obstruction, and the presence or absence of isolated hepatic segments was evaluated using percutaneous transhepatic cholangiography as a gold standard., Results: In all patients, 3D CTC demonstrated dilated intrahepatic ducts up to tertiary branches. 3D CTC correctly diagnosed the level of biliary obstruction and demonstrated isolated segments in all patients. In determining the cause of biliary obstruction, one patient with hilar cholangiocarcinoma was misdiagnosed as having biliary invasion by hepatocellular carcinoma., Conclusion: 3D CTC with minIP can determine the level and cause of biliary obstruction. 3D CTC can be obtained from regular thin-section helical CT data and may be a strong competitor against diagnostic magnetic resonance cholangiography because of its superior resolution and information on adjacent soft tissues and the duct itself.

Isolated metastatic tumors of the urinary bladder are extremely rare. We report three cases of isolated bladder metastasis from stomach cancer, which were proved at transurethral biopsy or total cystectomy. The lesions appeared as focal or diffuse thickening of the bladder wall on computed tomography. No other metastatic lesion was detected on imaging studies, which made the diagnosis of bladder metastasis difficult. The possibility of metastatic bladder tumor should be considered when the bladder wall is thickened focally or diffusely in a patient treated with stomach cancer.

Purpose: To evaluate the incidence of, predisposing factors for, and clinical outcome of liver abscess developing in patients with hepatic tumors after transcatheter oily chemoembolization (TOCE)., Materials and Methods: During the past 6-year period, 2,439 patients with hepatic tumors underwent a total of 6,255 TOCE procedures. With a retrospective review of medical records, the authors evaluated the occurrence of liver abscess, the statistical significance of potential predisposing factors including portal vein obstruction, metastatic tumors, biliary abnormalities (type 1, simple biliary obstruction; type 2, status prone to ascending biliary infection), malignant gastrointestinal mucosal lesions, and additional gelatin sponge particle embolization in liver abscess formation, and the clinical outcome of abscess., Results: Fifteen liver abscesses occurred in 14 patients (0.2%). Liver abscesses developed in three of 987 (0.3%) TOCE procedures for portal vein obstruction, three of 114 (2.6%) procedures for metastatic tumors, one of 49 (1.8%) for type 1 biliary abnormality, four of 55 (7.4%) for type 2 biliary abnormality, two of 18 (11.1%) for malignant gastrointestinal mucosal lesion, and nine of 2,108 (0.4%) for additional gelatin sponge particle embolization. Univariate and multivariate statistical analysis showed that type 2 biliary abnormality was a significant predisposing factor. The mortality related to liver abscess occurred in two patients (13.3%). Thirteen liver abscesses were successfully treated with parenteral antibiotics and percutaneous catheter drainage. However, irreversible deterioration of liver function occurred in two patients. Two of nine further TOCE procedures in three patients caused recurrent septicemia and liver abscess., Conclusion: The biliary abnormality prone to ascending biliary infection was the most important predisposing factor to the development of liver abscess after TOCE. Postembolic liver abscess could be effectively managed with percutaneous catheter drainage.

Background: The purpose of this study was to make a quantitative comparison between conventional and harmonic power Doppler (PD) ultrasound (US) in depicting vascularity of hepatocellular carcinoma (HCC)., Methods: Ten nodular HCCs in 10 patients were prospectively examined using a 2-4-MHz convex transducer and a standardized examination protocol. Serial US images were obtained before and 20, 30, 40, 50, 60, 90, 120, 150, 180, 240, and 300 s after intravenous injection of 2 g of contrast agent using conventional and harmonic PD US. The percentage of area with Doppler signal within each HCC nodule (%PDA) was calculated in each image with a PC-based image analysis program, and the results with both US techniques were compared., Results: In the majority of cases, %PDA was greater on conventional PD US than on harmonic PD US. Mean %PDA of 10 HCCs was significantly higher on conventional PD US than on harmonic PD US except at 20 s after injection. The highest values of mean %PDA were 34.9% in conventional PD US and 19.5% in harmonic PD US at 60 s after injection., Conclusion: Area with PD signals within the HCC is smaller and the duration of effective enhancement is shorter in harmonic PD US than in conventional PD US.

Purpose: The purpose of this work was to define the imaging spectrum of Castleman disease of the abdomen and to correlate the results with clinicopathologic findings., Method: Seventeen patients (male/female 7:10; mean age 35.6 years) with pathologically proved Castleman disease in the abdomen were included in this study. Radiologic findings (CT, n =17; US, n =10; MR, n =1) were retrospectively reviewed by two readers and were correlated with clinical and pathologic findings., Results: Subjects were divided into those with localized (n = 11) and disseminated (n = 6) disease. In localized disease, the pathologic subtypes were hyaline vascular type in eight and plasma cell type in three. Radiologic studies showed a single large mass in six and a single dominant mass with small satellite nodules in five. Central low attenuation was seen in two cases, and calcification was seen in three cases. Regional lymphadenopathy was found in five cases. In disseminated disease, there were three hyaline vascular types and three plasma cell types. Radiologic findings included diffuse lymphadenopathy (n = 6), hepatosplenomegaly (n = 5), ascites (n = 3), and thickening of the retroperitoneal fascia (n = 3). Disseminated disease revealed symptoms and abnormal laboratory findings (anemia, hypoalbuminemia, elevated erythrocyte sedimentation rate/C-reactive protein, etc.) more frequently than localized disease and showed poor prognosis., Conclusion: There are two distinctive types of radiologic manifestations in Castleman disease of the abdomen: localized and disseminated. The localized type usually shows single or multiple discrete masses, and the disseminated type frequently shows nonspecific organomegaly and lymphadenopathy.

Purpose: To evaluate radiologic findings of peripheral T-cell lymphoma (PTCL) of the colon at double-contrast barium enema examination., Materials and Methods: Double-contrast barium enema findings in six patients with pathologically proved PTCL of the colon were retrospectively evaluated and compared with colonoscopic and histopathologic findings., Results: There was a diffuse involvement of almost all segments of the colon in four patients and a focal segmental involvement in two. Frequent findings at double-contrast barium enema examination included geographic ulcerations (n = 6), aphthous ulcerations (n = 4), pseudopolyps (n = 4), circumferential luminal narrowing (n = 4), and ileocecal deformity (n = 4)., Conclusion: PTCL of the colon manifested as either a diffuse or a focal segmental lesion and showed extensive mucosal ulceration at double-contrast barium enema examination. These findings are similar to those of inflammatory bowel disease and are different from those of colorectal lymphoma with the B-cell phenotype.